This article was last reviewed on
This article waslast modified on January 15, 2019.
What is pancreatic cancer?

Cancer is an uncontrolled growth of abnormal cells that form tumors, damage normal tissue, and that may eventually spread (metastasize). Most pancreatic cancers (about 95%) develop in the pancreatic ducts and sometimes develop in the enzyme-producing cells of the exocrine pancreas.

The pancreas is a narrow, flat organ about six inches long with head, middle, and tail sections. Inside the pancreas, small ducts (tubes) feed digestive enzymes produced by the pancreas into the pancreatic duct.

Endocrine pancreatic tumors, also known as islet cell tumors, are usually less aggressive than exocrine tumors and are more rare. The majority of them are benign tumors that do not metastasize, although some are malignant. Islet cell tumors include gastrinomas, glucagonomas, and insulinomas and occur in the pancreatic cells that make the hormones gastrin, glucagon, and insulin, respectively. They often are detected earlier than exocrine cancers because they cause the signs and symptoms of excessive amounts of insulin and glucagon. Simple blood tests for these hormones are used to measure hormone levels in the blood and confirm if the levels are in fact elevated.

Because they are more common and aggressive, the remainder of this discussion focuses on exocrine cancers. Unfortunately, these cancers are hard to detect at an early stage. Since the pancreas is deep in the body, developing tumors cannot usually be seen or felt during a physical examination. By the time symptoms develop, the cancer has often spread throughout the pancreas and beyond.

According to the American Cancer Society, rates of pancreatic cancer have been slowly increasing over the past 10 years. In 2014, a projected 46,420 Americans will be diagnosed with pancreatic cancer and an estimated 39,590 will die from it. Pancreatic cancer is the fourth leading cause of cancer death in the United States, primarily because only about 10% of the cancers are still contained within the pancreas at the time of diagnosis.

Accordion Title
About Pancreatic Cancer
  • Risk Factors

    The main risk factor for pancreatic cancer is smoking. About 30% of pancreatic cancers are thought to be a direct result of cigarette smoking. Other risk factors include:

    • Age (most often seen in people older than 60)
    • Whether a person is a male or female (men are 30% more likely to develop pancreatic cancer than women)
    • Chronic pancreatitis
    • Diet (a diet high in meats and fats appears to increase risk)
    • Diabetes mellitus
    • Exposure to industrial chemicals, such as certain pesticides and petroleum products
    • Family history (an inherited tendency may be a factor in 5% to 10% of cases)

    It should be noted that most people who have known risk factors do not get pancreatic cancer, and many who do get pancreatic cancer have none of these risk factors.

  • Signs and Symptoms

    Early symptoms of pancreatic cancer are often either absent or subtle. They include:

    • Abdominal and/or back pain
    • Pruritus
    • Nausea
    • Loss of appetite
    • Unexplained weight loss
    • Jaundice

    Since these symptoms are seen in other conditions besides cancer, they may be ignored or missed in the early stages. By the time chronic pain, nausea, vomiting, malabsorption, and, in some rare instances, problems with blood sugar control surface and are recognized, the pancreatic cancer has usually spread.

  • Tests

    There are no established laboratory tests for the early detection or diagnosis of pancreatic cancer. Diagnosis is usually made by imaging tests and a tissue biopsy, and most cancers have already metastasized by this time.

    Some imaging tests that may be used to detect pancreatic cancer include:

    • Computed tomography (CT) scan: useful for detecting pancreatic masses and checking for metastasized cancer
    • Endoscopic retrograde cholangiopancreatography (ERCP): a flexible scope is inserted into the pancreatic duct and a dye is injected. X-rays can then reveal abnormalities in the structure of the pancreas due to the presence of a tumor. If abnormal areas are identified, a biopsy can be performed.
    • Magnetic resonance cholangiopancreatography (MRCP): a type of magnetic resonance imaging (MRI) used to see the pancreas, its ducts, and the bile ducts more clearly; often used before or instead of ERCP because it is faster and noninvasive; also useful in distinguishing pancreatitis from pancreatic cancer

    For more information on imaging studies, see

    Laboratory tests that may show abnormal results but are not diagnostic of pancreatic cancer include the following:

    • Comprehensive metabolic panel: a group of tests that may be used to evaluate liver and kidney function and to determine why someone is jaundiced
    • CA 19-9 (Cancer antigen 19-9): a tumor marker for pancreatic cancer; it may be used to distinguish pancreatic cancer from other cancers or to monitor for cancer recurrence. It is not currently useful for detection or diagnosis by itself because non-cancerous conditions can cause elevated CA 19-9 levels. Recent research, however, suggests that it may be useful for early detection of pancreatic cancer when combined with a promising new microRNA-detecting test that is still under investigation.
    • CEA (Carcinoembryonic antigen): a tumor marker used as a monitoring tool
    • Amylase: blood level may be elevated
    • Other tests, such as fecal fat, stool trypsin, serum trypsinogen, and lipase, may be ordered to help evaluate how well the pancreas is functioning and to determine whether pancreatic enzyme supplementation is necessary.

    A biopsy may be used to confirm a diagnosis of cancer through examination of pancreatic tissue.

  • Treatment

    Treatment of pancreatic cancer is based on establishing what stage the cancer is in by determining how much of the pancreas is involved and whether the cancer has spread. This may be done using a formal staging/naming system or by categorizing the cancer into one of the following types: resectable (can be surgically removed because still located within the pancreas), locally advanced (spread into nearby organs and not resectable), or metastatic (spread to distant organs).

    Unfortunately, pancreatic cancer can be categorized as resectable less than 15% of the time. How much surgery should be done depends on where the tumor is, its size, how far it has spread, and the condition of the affected person's health.

    Pancreatic surgery is very difficult. It requires an experienced surgeon, is associated with significant complications, and requires several weeks of recovery time. Procedures intended to treat pancreatic cancer include the Whipple procedure, distal pancreatectomy, and total pancreatectomy. For more on these, see the Johns Hopkins Kimmel Cancer Center's page on Pancreatic Cancer Surgery.

    Radiation and chemotherapy may be used to treat pancreatic cancer and typically are necessary because often tiny, undetectable amounts of a tumor will have spread by the time a surgery is done. Regrettably, pancreatic cancer does not respond well to current treatments. Gemcitabine and 5-fluorouracil (5-FU) are the most commonly used chemotherapy agents. They may be used alone or in combination with other drugs.

    Research into new treatment options known as "targeted therapies" is an active and ongoing field. Attempts to develop new drugs that have specific targets are meant to have fewer side effects than current chemotherapy drugs. Examples include pancreatic cancer growth factor inhibitors, anti-angiogenesis factors that block new blood vessels essential for cancer growth, and drugs that target substances involved in the spread of pancreatic cancer.

    For those with recurring or inoperable pancreatic cancer, palliative (comfort-oriented) care is the primary priority. Radiation, chemotherapy, and surgery may be used to help relieve pain. Surgery may also be performed to cut nerves to help relieve pain that is resistant to other measures.

    People with inoperable pancreatic cancer may want to consider enrollment in clinical trials that assess new treatments. Learn more about clinical trials at the National Cancer Institute website.

View Sources

Sources Used in Current Review

Pancreatic Neuroendocrine Tumors (Islet Cell Tumors) Treatment (PDQ®). (Updated April 17, 2014.) National Cancer Institute. Available online at through Accessed April 2014.

Pancreatic Islet Cell Tumor. (Updated Mar. 14, 2012.) MedlinePlus. Available online at through Accessed March 2014.

What Are the Key Statistics About Pancreatic Cancer? (Updated Feb. 5, 2014.) American Cancer Society. Available online at through Accessed March 2014.

Dragovich, Tomislav, et. al. (Updated Feb. 3, 2014.) Pancreatic Cancer. Medscape. Available online at through Accessed March 2014.

Chustecka, Zosia. (Jan. 21, 2014.) New Test for Pancreatic Cancer Based on MicroRNAs in Blood. Medscape. Available online at through Accessed March 2014.

Blood Tests. Pancreatic Cancer Association. Available online at through Accessed March 2014.

Huffman, Jason L., et. al. (Updated Dec. 9, 2013.) Chronic Pancreatitis. Medscape. Available online at through Accessed March 2014.

Surgery for Pancreatic Cancer. (Updated Feb. 5, 2014.) American Cancer Society. Available online at through Accessed March 2014.

What's New in Pancreatic Cancer Research and Treatment? (Updated Feb. 5, 2014.) American Cancer Society. Available online at through Accessed March 2014.

Sources Used in Previous Reviews

Thomas, Clayton L., Editor (1997). Taber's Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition].

Pagana, Kathleen D. & Pagana, Timothy J. (2001). Mosby's Diagnostic and Laboratory Test Reference 5th Edition: Mosby, Inc., Saint Louis, MO.

American Cancer Society. Pancreatic Cancer Detailed Guide. PDF available for download through

Mayer, R. (1999 – 2002 copyright). Pancreatic Cancer. The National Pancreas Foundation [On-line article]. Available online at through

NCI (2002, February 8, posted). What you Need to Know about Cancer of the Pancreas. National Cancer Institute, [On-line information]. Available online through

Reid, C. (1996 October). Probing the Pancreas. U.S. Food and Drug Administration [On-line article]. Available online at through

National Cancer Institute (2002, September, posted). PDQ Pancreatic Cancer Treatment. Available onlien through

NPF. Pancreatic Cancer, Frequently Asked Questions. The National Pancreas Foundation [On-line information]. Available online at through

Mayo Clinic (2002, August 5). What is Pancreatic Cancer? Mayo Clinic [On-line information]. Available online at through

American Cancer Society. Cancer Facts and Figures 2006 [On-line information]. Available online through

(2010 May) What you need to know about Cancer of the Pancreas. National Cancer Institute [On-line information]. PDF available for download at through Accessed January 2011.

(© 2010). Confronting Pancreatic Cancer, FAQ's. Pancreatica [On-line information]. Available online at through Accessed January 2011.

(Revised 2010 October 20). How is Pancreatic Cancer Diagnosed? American Cancer Society [On-line information]. Available online at through Accessed January 2011.

(Modified 2010 June 9). Basics of Pancreatic Cancer, FAQs. John Hopkins Medicine, The Sol Goldman Pancreatic Cancer Research Center [On-line information]. Available online at through Accessed January 2011.

Pagana, K. D. & Pagana, T. J. (© 2011). Mosby's Diagnostic and Laboratory Test Reference 10th Edition: Mosby, Inc., Saint Louis, MO. Pp 58-60, 208-209, 223-224, 619-620. Endoscopic retrograde cholangiopancreatography (ERCP). Avaiable online at through Accessed January 2012.